• Sanghee Park, Hyung Gon Lee, Jeong Il Choi, Seongheon Lee, Eun-A Jang, Hong-Beom Bae, Jeeyun Rhee, Hyung Chae Yang, and Seongtae Jeong.
• Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea.
• BMC Anesthesiol. 2019 Jan 5; 19 (1): 3.

BackgroundIn intubation using fiberoptic bronchoscope (FOB), partial or complete obstruction of upper airway makes the FOB insertion difficult. Thus, maneuvers to relieve such obstructions are recommended. There have been no studies to determine whether the sniffing or neutral position is superior for this purpose. Therefore, this study was performed to examine the effects of these two positions including vocal cord view.MethodsFifty-four patients scheduled to receive general anesthesia by orotracheal intubation were eligible for inclusion in the study with informed consent. After confirmation of proper head positioning depending on the group, the view of the vocal cord was acquired in each position. Images were reviewed using the percentage of glottic opening (POGO) score.ResultsA total of 106 images of vocal cords from 53 patients were obtained. The mean of difference of POGO score was 11.09, higher for the neutral position and standard deviation was 23.73 (p = 0.002). Neutral position increased POGO score in 31 patients and decreased POGO score in 13 patients compare to sniffing position (p = 0.017). There were no significant differences between the two head positions with regard to intubation time or degree of convenience during intubation.ConclusionsNeutral position improved the view of glottic opening than sniffing position during oral fiberoptic intubation. However, there was no difference in the difficulty of tube insertion between the two positions.Trial RegistrationClinical Trials.gov identifier: NCT02931019 , registered on October 12, 2016.

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